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2. 

4. CITY OF ELLISVILLE

   1 Weis Avenue

   Ellisville, Missouri 63011

   Phone: 636-227-9660  

   Fax: 636-227-9486

   Emergency Contacts for AFTER HOURS in the event of burglary, fire, etc. at your Business/Company

   
   

6. PLEASE FILL IN ALL REQUIRED FIELDS

8. INSTITUTION NAME:*
9. ADDRESS:*
11. SUITE:
12. TELEPHONE NUMBER 1:*
13. TELEPHONE NUMBER 2:*
14. FAX NUMBER:
16. MAIN EMAIL ADDRESS:*

18. EMPLOYEES TO BE CONTACTED IN ORDER LISTED BELOW (After-Hour Telephone Numbers)

20. Contact Person #1 Name:*
21. Home/Other Phone:*
22. Cell Phone:*
24. Contact Person #2 Name:*
25. Home/Other Phone:*
26. Cell Phone:*
28. Contact Person #3 Name:
29. Home/Other Phone:
30. Cell Phone:
32. ALARM COMPANY NAME:*
33. ALARM COMPANY PHONE:*
35. ALARM COMPANY ADDITIONAL INFORMATION:*
37. Full-time Employees*
38. Part-time Employees*
39. Total Employees*

41. ALL information needs to be filled out so the Police Department can make emergency contact when necessary. Any time you have changes in emergency contact listings, please notify us so your information can be updated. Please type or print neatly. Mail, fax or email changes to the Police Department, Ashlee Kalliongis, akalliongis@ellisville.mo.us and businesslicense@ellisville.mo.us

    
    

    version: 07/10/2025

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